Town of Riga
DOG IDENTIFICATION #
Dogs Name
Microchip No.
DOG LICENSE
Dog Breed
Dog Color(s)
LICENSE TYPE
Dog’s Yr. of Birth Last 2 Digits
ORIGINAL
RENEWAL
TRANSFER OF OWNERSHIP
Markings
OWNER’S PHONE NO.
OWNER IDENTIFICATION
Last
First
Middle Initial
Area Code
Mailing Address: House No. Street or R.D. No. and P.O. Box No.
Phone No.
City
State
Zip
County
Town, City or Village
TYPE OF LICENSE
Fee
1. Male, neutered/Female, spayed
9.00
2. Male, unneutered/Female, unspayed
17.00
Please make your check payable to the Town of Riga.
Please also send a copy of the rabies certificate and neutered/spay certificate if applicable.
All dogs 4 mos. & older must be licensed in the Town that they reside.
Office Use Only- Rabies Info:
Vet: ________________________
Manufacturer: ________________
_________________________________________________________________________________
Owner’s Signature
Date
Serial Number: _______________
Date Vacc: ________________ 1 or 3 year
________________________________________________
Clerk’s Signature
Date
Please mail or drop off at the Town Hall, PO Box 377 (6460 Buffalo Road), Churchville NY 14428